The intracellular hepatitis B surface antigen (HBsAg) content per cell was increased by 7.2-fold in the culture with 1.5% dimethyl sulfoxide (DMSO) compared with that in the control without DMSO, while the extracellular HBsAg production and specific productivity were only improved by 70% and 3.2-fold, respectively. Electron microscope has been employed to reveal large dilated structures within recombinant CHO cells in the presence DMSO. The dilated structures have a distribution within whole cytoplasm, and some dilated areas were engulfed in the nucleus. These large, dilated structures were not observed in the control. Immunogold labeling was used to discover the accumulated HBsAg was localized within these dilated areas, and some HBsAg-specific labels were detected in the nucleus membrane, owing to the encroachment of the dilated areas upon nucleus. The result could help to reveal the mechanism of intracellular HBsAg accumulation in the presence of DMSO.

In this paper, the effects of the blend of nanoparticles and microneedle matrix materials on the mechanical properties of dissolving microneedles were studied mainly, so as to construct microneedles with excellent mechanical properties. Different kinds of nanoparticles (calcium carbonate, hydroxyapatite, silica), particle sizes (20, 60, 100 nm) and the proportion of prescription (2%, 6%, 10%) were blended with the matrix material [polyvinyl pyrrolidone (PVP), poly(1-vinylpyrrolidone-co-vinyl acetate)(PVP/VA)] to form dissolving microneedles. The effects of nanoparticles on the elastic modulus and hardness of the microneedles were investigated using a nanoindenter. The results showed that the elastic modulus and hardness of PVP microneedles were significantly improved by nano-calcium carbonate (P < 0.001), and the elastic modulus and hardness of PVP/VA microneedles were significantly improved by nano-hydroxyapatite (P < 0.001). When the particle size of hydroxyapatite was 20 nm, the elastic modulus of PVP/VA microneedles was (10.6 ± 1.0) GPa, and the hardness was (0.47 ± 0.06) GPa. As the size of the nanoparticles increases, the mechanical performance of the microneedles decreases. When the mass proportion of nano-hydroxyapatite increased from 2% to 6%, the elastic modulus and hardness of the microneedles were significantly improved (P < 0.001), but the effect of continue increasing the proportion of nanoparticles on the microneedles was not significant. The nano-enhanced PVP/VA dissolving microneedles has no irritant effect on intact skin and has a slight irritation to damaged skin, but they disappear completely after 72 h. Animal experiments have been approved by the Laboratory Animal Welfare and Ethics Committee of Zhejiang University of Technology. Therefore, the nano-enhanced dissolving microneedles has good biological safety. To sum up, it is necessary to select the appropriate kind of nanoparticle, particle size, and prescription ratio when microneedles constructing with a given matrix material, so as to effectively improve its mechanical performance.

OBJECTIVETo introduce the application of pedicled anterolateral thigh (ALT) flap for total penile reconstruction and to investigate its feasibility and effect.

METHODSFrom May 2011 to May 2015, 12 male patients presented with absence of the penis or congenital malformation received phalloplasty with the pedicled ALT flap. Of them, the median age was 35 years old (range, 20-57 years). The size of the flaps ranged from 11 cm x 11 cm to 12 cm x 15 cm. 8 patients underwent urethra reconstruction with tube-in-tube flaps and other 4 patients with scrotal septal flaps. In this series, we performed one-stage urethral anastomosis in 4 cases and second-stage urethral anastomosis 6 months after the phalloplasty in 8 cases.

RESULTSAn acceptable reconstructed phallus was achieved in 10 patients. These flaps were primarily healed with satisfactory functional and cosmetic results. The reconstructed penis was completely necrosis because of the flap failure in one case. The distal half of the phallus was lost due to infection in one case. Both of them were treated with pedicled ALT flap from the other side. Reliable results were achieved. At a median follow-up of 1.5 year (range 1 to 4 years), 9 patients (90%) were fully satisfied with phallic cosmesis and size, and 4 patients who was married had successful sexual intercourse. 8 patients had normal urinate function. Fistula was developed in 2 patients (20%) which was treated with delayed repair at 6-12 months with local scrotal flaps.

CONCLUSIONSThe pedicled ALT flap can be simply used to reconstruct an entire penis as well as a urethra. It has several advantages including a less conspicuous donor site, greater bulk, better color match and no necessary for microsurgery.

Adult ; Anastomosis, Surgical ; methods ; Coitus ; Feasibility Studies ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Necrosis ; etiology ; Penis ; abnormalities ; surgery ; Reconstructive Surgical Procedures ; methods ; Scrotum ; Surgical Flaps ; pathology ; transplantation ; Thigh ; Time Factors ; Urethra ; surgery ; Young Adult

AIM: To investigate the feasibility and clinical effect of punctoplasty by using trabeculectomy punch combined with a novel RS tube for the treatment of punctal stenosis.METHODS: Totally 39 patients (39 eyes) with punctual stenosis were selected from October 2013 to October 2015 in the Second People`s Hospital of Foshan.All patients underwent punctoplasty by using trabeculectomy punch combined with a novel RS tube.These tubes were removed at 3mo after operation.A follow-up of 6mo was taken for final analysis.The fluorescein dye disappearance test score was recorded before the operation and at 1,3 and 6mo after the extubation.The curative effect of the operation at 6mo after the extubation was assess.RESULTS: Fluorescein dye disappearance test: the scores at 1,3 and 6mo after the extubation all decreased compared with the preoperative ones.The difference was statistically significant(P<0.05).At the last following up, 35 eyes (90%) were cured completely, 4 eyes (10%) were improved significantly, no patients recurred.Effective rate was 100%.No serious intraoperative and postoperative complications happened.CONCLUSION: Punctoplasty by using trabeculectomy punch combined with novel RS tubes is a safe and effective method for the punctul stenosis, which is easy to perform, with high success rate.

To investigate the influence factors and effects of metal or dissolving microneedles on the formation and healing of skin microchannels, the pencil-shaped or conical stainless steel microneedles with different lengths, tip to tip space and base area, and the pencil-shaped dissolving microneedles with different tip to tip space were used. The microneedles were applied to the skin of epilatory mice and rats, and the effects of various microneedle parameters, application parameters, and animals on the microchannels were explored by the transepidermal water loss (TEWL) and methylene blue staining. Visually observe the skin local irritation caused by the microneedles. The animal experiments were approved by the Animal Experiments Welfare and Ethical Committee of Zhejiang University of Technology. The application time of the microneedle should be maintained at 30 s or more. When the insertion forces were 2, 4, 8 N, and the TEWL initial values of the formed microchannels were 12.9, 33.0, 40.4 g·m^-2·h^-1, respectively. When the length of metal microneedle were 400, 600, 800 μm, and the TEWL initial values of the formed microchannels were 37.1, 40.4, 49.5 g·m^-2·h^-1, respectively. When the tip to tip space of metal microneedle were 400, 600, 800 μm, and the TEWL initial values of the formed microchannels were 33.2, 40.4, 55.8 g·m^-2·h^-1, respectively. When the base area of metal microneedle were 0.16, 0.35, 0.62 cm², and the TEWL initial values of the formed microchannels were 35.1, 40.4, 67.1 g·m^-2·h^-1, respectively. The effects of conical and pencil-shaped microneedles are similar. When the tip to tip space of pencil shaped dissolving microneedle were 400, 600, 800 μm, and the TEWL initial values of the formed microchannels were 49.8, 60.5, 70.5 g·m^-2·h^-1, respectively. The TEWL baseline values of animal skins of different genders and series are different, but the tendency of microchannels formation and closure is similar. Visual inspection revealed that the slight erythema caused by the microneedles subsided within 24 h. Microneedles of different parameters have different effects on microchannels. The microchannels closed within 24 or 48 h, and the skin local irritation caused by microneedle was mild.

OBJECTIVETo explore the situation and cause of new reported HIV/AIDS cases and death of HIV cases in Henan province from 2008 to 2009.

METHODSThe data of HIV/AIDS cases in Henan province before the end of 2009 was downloaded from "the history card downloading site" of the national online case reporting system on Jan. 5(th), 2010. There were 6990 HIV/AIDS new cases reported from 2008 to 2009, and 1214 cases died. Descriptive study was implemented including population characteristics of new reported HIV/AIDS cases and dead cases from 2008 to 2009. Survival time and cause of death were analyzed.

RESULTSAmong all the dead cases, the Han nationality accounted for 99.0% (1202 cases), and males were more than females (62.0% (753 cases) vs 38.0% (461 cases)), 64.7% (786 cases) were married, those under junior high school education level accounted for 93.7% (1137 cases), AIDS patients accounted for 93.2% (1131 cases) and 6.8% (83 cases) were HIV carriers; 65.5% (795 cases) were former plasma donors and transfusion blood/blood produces. The main cause of death were AIDS-related diseases, the proportion was 71.9% (873 cases). The median survival time after confirmed HIV positive was 62 days (Q(L) = 14 d, Q(U) = 151 d), 35.9% (436 cases) cases died in one month and 79.0% (959 cases) cases died in six months after confirmed HIV positive.

CONCLUSIONThe newly reported dead cases of HIV/AIDS were mainly infected through former plasma donation and transfusion blood/blood produces in 2008 and 2009. The main cause of death was AIDS-related diseases.

Acquired Immunodeficiency Syndrome ; epidemiology ; mortality ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Child, Preschool ; China ; epidemiology ; Female ; HIV Infections ; epidemiology ; mortality ; Humans ; Infant ; Male ; Middle Aged ; Young Adult

Objective To investigate the application of the repeated expanded bilateral deltopectoral flap for resurfacing severe facial cervical scar, with review of relating articles to discuss issue of repeated expanding flap.Methods Nine patients suffered from hyperplastic facial and cervical scar.Two soft tissue expanders were implanted into the anterior chest region at both sides of sternum.The center of inner border of the expander was at the cross of second intercostal and parasternal line, and the lengthways axe of the expander was located at the ligature of the second intercostals and mammary areola.After two weeks when the expander was filled, expanded flap was transferred to cervical defect.The transferred flap was repeated expanded after half a year and transferred to resurface facial defect.Results In the first expansion stage, 600 or 800 ml expander were implanted in each side of sternum.In the second stage, 400 or 500 ml were used.The first stage of expanding process was smooth, and 2 of the expanding flaps were ruptured during the second expansion period.400-520 cm2 (average 440 cm2) additional expanded flap was acquired during two stages of expanding.Conclusions The repeated expanded bilateral deltopectoral flap gives us greater opportunity to repair severe facial-cervical scar.The best interval time of the two-stage expansion is over half a year.The speed of second expansion should be lower than that in the first stage, and protecting the expanding flap carefully from external force compression is needed during the second expasion.

As a novel transdermal drug delivery technology of minimally invasive, safe and efficient, microneedles have received increasing attention. The microchannels formation by microneedles onto the skin is a prerequisite and key for microneedles to deliver drugs. However, there is still a lack of systematic evaluation in skin microchannels. This review summarized influencing factors and evaluation methods in microchannels formation and healing by microneedles, including geometric parameters, materials for preparation, drugs, penetration parameters, differences among the skin of subjects, and presence or absence of occlusion. This review provides reference for other scholars to further study the effectiveness and security of microneedle applications.

BACKGROUNDAdvances in minimally invasive surgical techniques and neonatal intensive care for neonates have allowed for repair of the neonatal esophageal atresia with tracheoesophageal fistula (EA/TEF) to be approached endoscopically. However, thoracoscopic surgery in children is still performed in only a few centers throughout the world. The aim of this study was to compare the neonatal tolerance to the thoracoscopic repair (TR) and the open repair (OR) and also to discuss anesthetic management in thoracoscopic procedure.

METHODSWe performed a prospective study enrolling newborns diagnosed with EA with distal TEF (type C) receiving the repair surgery between June 2009 and January 2012 in our institution. Data collected included the newborns' gestational age and weight at the time of the operation, operative time, parameters of intraoperative mechanical ventilation, oxygenation, end-tidal carbon dioxide (ETCO2), and analysis of blood gases. Time to extubation and length of stay were also recorded.

RESULTSIntravenous induction with muscle paralysis followed by pressure-control ventilation and tracheal intubation regardless of the position of the fistula can be performed uneventfully in EA/TEF newborns with no additional airway anomalies and large, pericarinal fistulas in our experiences. The thoracoscopic approach appeared to take longer than the open approach. During the procedure of repair, hypercarbia and acidosis developed immediately 1 hour after pneumothorax in both groups. CO2 insufflation did have additional influence on the respiratory function of the newborns in the TR group; values of PaCO2 and ETCO2 were higher in the TR group but the difference did not reach statistical significance. By the end of the procedure, values of PaCO2 and ETCO2 returned to the baseline levels while pH did not, but all parameters made no difference in the two groups. Besides, time to extubation was shorter in the TR group.

CONCLUSIONSThoracoscopic repair of EA/TEF is comparable to the open repair, and is believed to be safe and tolerable in selected patients. A wider range of neonates may be acceptable for thoracoscopic EA/TEF repair with increasing surgical experience.

Esophageal Atresia ; surgery ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Prospective Studies ; Thoracoscopy ; methods ; Tracheoesophageal Fistula ; surgery

OBJECTIVETo investigate the application of pedicled expanded flaps for the reconstruction of facial soft tissue defects.

METHODSThe expanded skin flaps, pedicled with orbicularis oculi muscle, submental artery, the branch of facial artery, superficial temporal artery, interior upper arm artery, had similar texture and color as facial soft tissue. The pedicled expanded flaps have repaired the facial soft tissue defects.

RESULTSBetween Jan. 2003 to Dec. 2013, 157 cases with facial soft tissue defects were reconstructed by pedicled expanded flaps. Epidermal necrosis happened at the distal end of 8 expanded flaps, pedicled with interior upper arm artery(4 cases), orbicularis oculi muscle(3 cases) and submental artery(1 case), which healed spontaneously after dressing. All the other flaps survived completely with similar color and inconspicuous scar. 112 cases were followed up for 8 months to 8 years. Satisfactory results were achieved in 75 cases. 37 cases with hypertrophic scar at incisions need secondary operation.

CONCLUSIONSIsland pedicled expanded flap with similar texture and color as facial soft tissue is suitable for facial soft tissue defects. The facial extra-incision and large dog-ear deformity could be avoided.

Cicatrix, Hypertrophic ; surgery ; Eyelids ; Face ; surgery ; Facial Muscles ; Humans ; Reconstructive Surgical Procedures ; Skin Pigmentation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply